Provider Demographics
NPI:1194056820
Name:NICKEL, JAMES RUSSELL (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RUSSELL
Last Name:NICKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60744
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92166-8744
Mailing Address - Country:US
Mailing Address - Phone:619-226-2800
Mailing Address - Fax:619-226-2805
Practice Address - Street 1:3446 HANCOCK ST
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4306
Practice Address - Country:US
Practice Address - Phone:619-226-2800
Practice Address - Fax:619-226-2805
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA23013207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology